As I study for the MCAT and tackle my final semester as a pre-med biology student, I am doing my best to immerse myself in what will hopefully be my future occupational sector — the healthcare industry. Through my coursework, volunteering at a community clinic and scribing part-time for local ophthalmologists, one undeniable factor emerges as a significant barrier to accessible healthcare: cost. 

What should be a basic necessity for all who are given the precious gift of life remains out of reach for a large percentage of citizens in the United States. Is there anything we can do to change that? 

Understanding the high costs of healthcare

One of the main reasons for exorbitant healthcare costs in the U.S. is administrative overhead. Instead of utilizing a nonprofit national health insurance model, the U.S. spends over $250 billion annually on unnecessary billing, profits and advertising — none of which have a positive effect on health outcomes. 

However, addressing administrative costs requires comprehensive policy proposals and reforms. A largely suggested reform involves the U.S. adopting a single-payer system — where one public entity, often the government, administers healthcare funding and payments — akin to those in other countries such as Australia or Canada. Another proposal is to make structural reforms to the current multi-payer framework — which is composed of private and government health insurance options. 

While these changes are crucial to improving both the cost and quality of healthcare for citizens, they demand a lot of time and effort. This begs the question: what can we do in the meantime? 

The role of medicalization 

Another high-value contributor to high healthcare costs comes from the way we go about medicalization. In the US, we prioritize disease management over preventative care. 

According to the Academy of Managed Care Pharmacy (AMCP), disease management is defined as an aim to reduce healthcare costs and enhance the quality of life for individuals with chronic conditions by preventing or minimizing the impact of those diseases through integrated care. 

While this approach makes sense in theory, it overlooks a critical issue: areas in the U.S. suffering from higher chronic disease rates are often those that are socioeconomically disadvantaged and highly populated by Black and Indigenous communities, according to the CDC. This is particularly evident in the Southeast, where many Black Americans have longer distances to travel to access healthcare services, compounded by systemic racism and policies that have historically marginalized them through low wages and limited Medicaid expansion.

From 1987 to 2000, the increased prevalence of chronic diseases accounted for an estimated $211 billion to the $314 billion surge in U.S. healthcare spending. Additionally, projections suggest that the number of individuals living with chronic diseases will rise from 133 million in 2005 to 171 million by 2030. 

The main cause of this rise? Lifestyle choices that include smoking, physical inactivity, excessive alcohol use and poor nutrition. 

Making healthcare accessible for everyone

To make healthcare accessible to all citizens — not just the privileged — we need to shift our focus toward clinical preventative care, which can be divided into three main categories. 

• Primary prevention: Aims to prevent disease before it occurs through behavioral and lifestyle management. 
• Secondary prevention: Involves early detection of diseases before symptoms manifest.
• Tertiary prevention: Focuses on managing existing diseases to prevent complications. 

I propose that we prioritize primary preventative care by expanding access to Telehealth and artificial intelligence (AI). We live in an era of ever-expanding digital acceleration, giving us the capabilities to make the unimaginable impossible, like having a physician in the palm of our hands. An AI assistant could compile medical, family and social histories, along with genetic and environmental factors, just like a physician, to recommend and guide users with tailored nutritional advice, exercise programs, mental health therapies and other lifestyle modifications to promote better health outcomes. 

The promise of AI in healthcare 

AI has the potential to achieve accuracy that exceeds human capabilities. 

As machine learning models become more sophisticated, and AI integrates itself into more critical decision-making processes, we see the rise of Explainable AI: the development of AI systems that provide understandable insights into their decision-making process. This allows users to have more trust in these systems, helping to eliminate biases and ensure fairness, comply with ethical and legal standards and see high rates of improvement and debugging from data scientists and engineers due to more understanding of how the models come to conclusions.

Given the decline in medical students choosing primary care and family physicians, coupled with the lack of access to specialists for the majority of the chronic disease population, an ultra-personalized, explainable AI physician can help to reduce the cost of healthcare. This solution can act as an effective interim while we advocate for better government policies. 

The high cost of healthcare in America is a pressing issue that demands immediate attention. Innovative solutions through technology and more focus on preventative care, let us take the necessary steps towards the goal of accessible healthcare to all, regardless of social status or economic background. 

It is a long journey to embark on but is well worth it if it means the greater health and well-being of our society.